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| BRIEF REPORT |
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| Year : 2017 | Volume
: 6
| Issue : 3 | Page : 115-117 |
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Color doppler correlates of pulmonary artery hypertension
Sita Ram Mittal
Department of Cardiology, Mittal Hospital and Research Centre, Ajmer, Rajasthan, India
| Date of Web Publication | 4-Jul-2017 |
Correspondence Address:
Sita Ram Mittal
XI/101, Brahmpuri, Ajmer - 305 001, Rajasthan
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2250-3528.209381
Mild systolic reduction in pulmonary artery flow is an echocardiographic sign of pulmonary artery hypertension. However, at times, it is difficult to appreciate and further grade it into mild, moderate, or severe. We regularly performed color Doppler and color M-mode echocardiography of pulmonary flow and observed that it is easier to interpret and grade the findings. Findings correlate with pulmonary artery pressure evaluated by tricuspid regurgitation jet. Four representative examples are presented. Keywords: Colour doppler, echocardiography, pulmonary artery hypertension
How to cite this article:
Mittal SR. Color doppler correlates of pulmonary artery hypertension. J Clin Prev Cardiol 2017;6:115-7 |
| Color Doppler Correlates of Pulmonary Artery Hypertension | |  |
Mid-systolic reduction in pulmonary artery flow is an echocardiographic sign of pulmonary artery hypertension. However, at times, it may be difficult to appreciate and grade it as mild, moderate, or severe. Color Doppler is sensitive and can be graded according to the duration of reversal in flow.
| Case Reports | | |
Case 1
This case depicts a normal flow [Figure 1]. A 48-year-old female was referred for echocardiography. Cardiovascular system examination was normal. Echocardiography was normal. There was only forward flow in main pulmonary artery during systole [Figure 1]a. There was no retrograde flow [Figure 1]b. Color M-mode [Figure 1]c showed only forward flow. These findings suggest normal pulmonary artery pressure as confirmed by pulsed Doppler imaging of tricuspid regurgitation flow [Figure 1]d. | Figure 1: (a) Color Doppler evaluation of pulmonary artery in early systole from a normal person showing forward flow (b) Color Doppler evaluation of pulmonary artery from the same patient in late systole showing no retrograde flow (c) Color M-mode of pulmonary artery flow showing forward flow throughout systole without any retrograde flow (d) Pulsed Doppler evaluation of tricuspid regurgitation jet showing normal right ventricle systolic pressure
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Case 2
This case depicts a mild reversal of flow [Figure 2]. A 30-year-old female of mitral stenosis was referred for echocardiography. On echocardiography, she had tight mitral stenosis (mitral valve area - 0.95 sqcm). Doppler of pulmonary artery flow [Figure 2]a was apparently normal. However, color Doppler [Figure 2]b showed small retrograde flow (red) toward the transducer. Color M-mode showed small amount of retrograde flow toward the end of systole [Figure 2]c-arrow]. Doppler evaluation of tricuspid flow showed mild pulmonary artery hypertension [Figure 2]d (right ventricular systolic pressure 39.4 mm Hg). | Figure 2: (a) Pulsed Doppler evaluation of pulmonary artery flow showing normal flow. (b) Color Doppler evaluation of pulmonary artery flow showing mild retrograde flow (red). (c) Color M-mode of pulmonary artery flow showing mild retrograde flow (arrow) (d) Pulsed Doppler evaluation of tricuspid regurgitation jet showing right ventricle systolic pressure of 39.4 mm Hg
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Case 3
This case depicts a moderate reversal of flow [Figure 3]. A 62-year-old female was referred for echocardiography with a complaint of effort breathlessness. Doppler of pulmonary artery flow showed systolic reversal [arrow in [Figure 3]a. Color Doppler evaluation of pulmonary artery showed moderate retrograde flow (red) [Figure 3]b. Color M-mode showed small forward flow (blue) followed by significant retrograde flow (red) [Figure 3]c-arrow]. | Figure 3: (a) Pulsed Doppler evaluation of pulmonary artery flow showing mid and late systolic retrograde flow (arrow). (b) Color Doppler evaluation of pulmonary artery flows showing moderate retrograde flow. (c) Color M-mode of pulmonary artery flow showing retrograde flow in mild and late systole (arrow)
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Case 4
This case depicts a significant reversal of flow [Figure 4]. A 54-year-old male was referred for echocardiography with complaint of effort breathlessness. Doppler evaluation of tricuspid regurgitation jet [Figure 4]a showed severe pulmonary artery hypertension (right ventricle systolic pressure 64.8 mm Hg). Short-axis view showed dilated pulmonary artery [Figure 4]b. Color Doppler evaluation showed marked systolic reversal of flow toward the transducer throughout systole [red in [Figure 4]c,[Figure 4]d and [Figure 5]a,[Figure 5]b. Color M-mode [Figure 5]c showed minimal forward flow (blue) followed by significant retrograde flow (red) starting in early systole. | Figure 4: (a) Doppler evaluation of tricuspid regurgitation jet showing right ventricle systolic pressure of 64.8 mm Hg. (b) Short-axis view showing dilated main pulmonary artery. (c) Color Doppler evaluation of pulmonary artery flow in early systole showing significant retrograde flow (arrow). (d) Color Doppler evaluation of pulmonary artery flow in mid systole showing significant retrograde flow (arrow)
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 | Figure 5: Echocardiograms from the same patient as in [Figure 4]. (a) Color Doppler evaluation of pulmonary artery flow in late systole showing significant retrograde flow (arrow). (b) Color Doppler evaluation of pulmonary artery flow in end systole showing persistent retrograde flow (arrow). (c) Color M-mode of pulmonary artery flow showing early forward flow followed by retrograde flow throughout rest of systole (arrow)
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During inspiration, pulmonary vascular bed dilates resulting in decreased pulmonary vascular resistance. Forward flow, therefore, increases and retrograde flow decreases during inspiration [Figure 6]a. Opposite changes occur during expiration. Similar changes are seen in color M-mode of pulmonary flow [Figure 6]b. | Figure 6: (a) Pulsed Doppler evaluation of pulmonary artery flow showing increased reversal of flow in expiration (arrow). (b) Color M-mode of pulmonary artery flow showing expiratory increase in flow reversal (arrow)
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No similar report could be found in literature.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
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